Food Facts
Your patient asks for some ice for their nectar thick chocolate Ensure, what do you do?
Pt cannot receive ice as it melts to a thin liquid. Explain to pt this is not safe to swallow. Can store ensure in the fridge and thicken after it is cold for patient.
Patient is on dysphagia soft diet with regular/thin liquids and wants a snack, what is an item you can grab them?
Jello, applesauce, ice cream, sherbert, pudding, PB, any liquids
Besides food, what should you ALWAYS make sure is documented in the flowsheets?
Meal intakes and supplement intakes. These are important for us to assess caloric intake. Could make a difference in placing a tube.
Who performs an MBS?
Speech Language Pathologist
An Ensure is how many ounces? And how many packets does it take of nectar thick to thicken the Ensure to honey thick?
Ensure is 8 oz. It would take 4 nectar thick packets or 2 honey thick packets.
Which items from the pantry cannot be thickened?
Ensure clear/boost breeze, ice cream, sherbert, popsicles, ICE, jello
If family brings in food, how do you document that?
Make a note in the flowsheets about what was brought in and how much was eaten. As specific as possible is best.
What are the signs that pt cannot safely swallow and should be evaluated?
- clear liquid from nose
- sounding underwater
- pocketing
- coughing/choking
Pt is on a clear liquid diet with honey thick liquids. He is requesting ensure clear. How many packets do you need to use to thicken 8oz of ensure clear?
NONE, ensure clear cannot be thickened. Pt can have thickened juice, water, or broth.
Pt is on honey thick liquids and asks you for ice cream. He reports he eats ice cream all the time at home and as long as it is frozen he can swallow it safely. What do you do?
Patient cannot have regular ice cream as it melts to a thin liquid. You can offer to ask the RD to order thrive ice cream which melts to honey thick.
What is the ideal way to document meal intakes in the flowsheets?
Preferred: percentage of each item consumed
If unable to put each specific item, percentage of the full meal is ok
What is the thickest liquid consistency (you won't see this often)
Pudding thick
Pt is on nectar thick liquids, you notice pt tray comes up with the orange juice thickened and in a clear cup. But the ensure is in the original container, what now?
Always double check that liquids are thickened to the right consistency on trays. Remove the ensure and use thickening agents in the pantry to thicken to the right consistency before giving to the patient.
If you don't have any honey thick packets available in the pantry, how many nectar thick packets do you use?
2 nectar thick packets for 1 honey thick packet
Why are calorie counts completed?
To have a patient start or stop tube feeds
How do you get in touch with your floor dietitian?
Epic message the floor RD signed in
Talk to RD when they are on the floor
Call the RD on call number (if no one signed in)
Pt has a 4 oz juice at bedside and is on a pureed diet with honey thick liquids. Pt needs the juice thickened. You have nectar thick available in the pantry. How do you thicken the juice?
You can use 2 nectar thick packets to thicken the 4 oz of juice to honey thick texture.
Honey Thick Per 4 Oz: 2 nectar thick or one honey thick
Pt is on a nectar thick diet and is requesting chicken noodle soup, what do you do?
Explain to the patient that they cannot have the noodles or anything in the soup. They can have nectar thick chicken broth.
What is often charted as a percentage (besides meals/supplements) that requires specific details for us to be able to assess calories?
SNACKS
when documented 100% in the snack column please also document the type of snack provided so we know how many calories the pt had
Why is feeding important? (assist with meals, calorie counts etc)
Improve wound healing
Prevent needing a PEG tube